This qualitative interview study (n=14) of the use of ayahuasca in those with severe physical illnesses (SPI) identified several psychological mechanisms that were being deployed (introspection, self-analysis, autobiographical memories, perspective changes, and more).
Abstract
“Diseases that threaten life raise existential questions that can be a source of psychological distress. Studies with psychedelics demonstrate therapeutic effects for anxiety and depression associated with life-threatening illnesses. Ayahuasca has been proposed as a possible therapeutic agent in the treatment of psychiatric disorders. Preliminary studies suggest that ayahuasca could promote therapeutic effects for people with physical illnesses. The aim of this study was to explore how the ritual use of ayahuasca during the treatment of severe physical illnesses (SPI) may influence the way people understand and relate to their illness, using qualitative methods to assess the participants’ perspectives. Participants who consumed ayahuasca ritualistically during the period of treatment for SPI were purposely chosen. Data were obtained through semi-structured interviews. A thematic analysis was performed with 14 individuals. The ritual experience with ayahuasca acted on the participants’ illness understanding through multiple psychological mechanisms, including introspection, self-analysis, emotional processing and catharsis, recall of autobiographical memories subjectively related to illness origin, illness resignification, and perspective changes. This study suggests that the experience with ayahuasca may facilitate illness acceptance through an influence on the meanings of the illness, life, and death. These changes may favor a more balanced relationship with illness and treatment.”
Authors: Lucas O. Maia, Dimitri Daldegan-Bueno & Luís F. Tófoli
Summary
Ayahuasca may promote therapeutic effects for people with physical illnesses by influencing the way they understand and relate to their illness through multiple psychological mechanisms, including introspection, self-analysis, emotional processing and catharsis, recall of autobiographical memories subjectively related to illness origin, illness resignification, and perspective changes.
Introduction
Severe physical illnesses (SPI) trigger existential issues that can be a source of deep distress. Serotonergic psychedelics have been shown to improve mental health in patients with SPI, reducing death anxiety and improving quality of life.
Ayahuasca is a psychedelic brew prepared from Banisteriopsis caapi and Psychotria viridis, used by several indigenous and mestizo groups for medicinal and ritual purposes. Its effects include perceptual, cognitive, and emotional changes, transpersonal experiences, and somatic effects.
Ayahuasca may have therapeutic properties for some psychiatric disorders, especially depression, and substance use disorders. Preliminary studies also suggest that ayahuasca ritual experience may promote therapeutic effects during the treatment of physical illnesses by improving coping strategies and enhancing well-being.
Methods
A qualitative study was conducted with participants who had participated in at least one ayahuasca ceremony after the diagnosis of an acute, prolonged, or chronic physical illness. The study considered the impact of ayahuasca on illness experience and the first experience with ayahuasca before or after diagnosis.
Data were obtained through semi-structured in-depth interviews with open-ended questions conducted face-to-face by the first author – a male researcher with qualitative research training. The interviews lasted two hours on average and were conducted with participants at their home or alternatively, in a previously chosen private place.
Interviews were transcribed and submitted to thematic analysis using an exploratory, inductive, and semantic approach, generating themes, subthemes, and topics. Data were coded manually by the first author, and the others evaluated the themes.
Results
A sample of 14 individuals with cancer, HIV infection, rheumatological, neurological, gastrointestinal, and dermatological diseases was interviewed. They were ritual users of ayahuasca in institutionalized religious groups and independent neo-shamanic groups, and underwent some type of therapy in addition to medical treatment and ritual use of ayahuasca.
Introspection, thought, and emotion
This theme encompasses subjective experiences lived during the effects of ayahuasca, such as self-therapy and positive feelings.
A participant described a psychological state induced by ayahuasca in which a subjective analysis of autobiographical and psychoemotional contents occurs, often followed by feelings of self-forgiveness and self-acceptance.
Ayahuasca experiences are associated with positive feelings, including peace, tranquility, relaxation, joy, self-esteem, trust, love, and gratitude, as a response to negative feelings raised by the circumstance of the illness.
The place of illness
This topic assembles themes that address how the ayahuasca ritual experience influences how participants understand and relate to illness.
Conceptions about the origin of the illness
The origin of illness was attributed in three ways by the participants: emotionally, spiritually, and behaviorally. The emotional sense was related to recurring negative feelings and emotions, while the spiritual sense was related to a process of spiritual illness.
Resignification and acceptance of illness
The ritual use of ayahuasca promotes an introspection state that contributes to the attribution of new meanings to the illness. This process could also reflect on the individual’s attitude toward therapeutics.
Perception, self-care, and treatment management
This theme was formed from reports suggesting that the ayahuasca experience may influence body perception, functioning, and interaction with the physiological manifestations of the disease. This may lead to increased self-care.
Life: priorities and habits
Some reports described changes in the way participants understand life, and how they relate to people, as a result of the illness experience and the ritual use of ayahuasca.
Hypothetical explanatory model
Ayahuasca promotes a state of introspection, which facilitates the processing of psychoemotional content. This self-therapy may help with illness-related anxiety issues by facilitating the attribution of new meanings to the illness itself as a tool for self-development, facilitating acceptance.
Discussion
The ritual use of ayahuasca during SPI treatment may facilitate illness acceptance through multiple psychological mechanisms, favoring a more balanced relationship with illness and treatment.
The ayahuasca experience induces an introspective state characterized by an increased recall of autobiographical memories and analysis of psychoemotional content. This introspective state promotes the reconciliation of unresolved emotional issues or trauma, which may be linked to illness acceptance and adherence to treatment.
The ritual experience with ayahuasca seems to act as a catalyst for therapeutic processes, similar to reports of studies with people with physical illnesses, substance dependence, and eating disorders.
The therapeutic effects reported could be due to both pharmacologic and placebo effects, given that the meaning of the illness experience is altered in a positive direction, and the ayahuasca ritual converges two elements with potential symbolic effects.
Ayahuasca use may affect body perception, the ability to perceive the interaction between body and disease, and self-care. It may also influence essential choices related to medical treatment, such as medication use and transplantation, and may facilitate individual empowerment to take appropriate responsibility for the management of their condition.
Participants mentioned that their illness evoked existential reflections in which death emerged with greater proximity, generating distress or fear. The experience induced by ayahuasca seemed to have amplified these reflections, lessening the fear and facilitating the acceptance of death.
Participants reported that the ritual use of ayahuasca fostered changes in lifestyle, favoring choices aimed at better health status. The motivation for change may be related to the reported improvements in clinical outcomes.
This study had important limitations, including the sample construction method favoring positive results and the use of self-reports subject to cognitive processes that may bias the reports.
In conclusion, this study suggests that ayahuasca may be useful in reducing psychological distress generated by experiencing SPI, and may inform future research on psychedelic-assisted therapies in people with severe illnesses. Ayahuasca-assisted therapy for seriously ill patients may require randomized controlled trials using standardized protocols, prospective observational studies using both quantitative and qualitative measures, proof of concept open-label trials, and then randomized placebo-controlled trials.